Support for Medical Home to Be Focus of Upcoming Bill

The patient-centered medical home soon could receive another boost on Capitol Hill. Senate Assistant Majority Leader Richard Durbin, D-Ill., and Sen. Richard Burr, R-N.C., plan to introduce a bipartisan bill within the next few weeks that would give states money to establish patient-centered medical home demonstration projects for Medicaid and State Children's Health Insurance Programs, or SCHIPs.

The bill, which is known as the Medical Homes Act of 2007, will be referred to the Health, Education, Labor and Pensions Committee.

"At a time when both health care costs and chronic illnesses are on the rise, we need a better way to provide care that is accessible, comprehensive, coordinated and cost-effective," Durbin said in a statement to AAFP News Now. "The Medical Homes Act of 2007 would make federal funding available for states to provide care to our nation's most vulnerable -- low-income children and families. The medical home can reduce costs and improve the quality of health care services for every individual in America."

The legislation probably will not be considered on its own because its focus is "too specific," said Kevin Burke, director of the AAFP Division of Government Relations. However, he added, it could be included in a larger bill later this year.

Even if Congress fails to approve the medical homes bill this year, the action of bringing the concept forward still would represent a bipartisan endorsement of the patient-centered medical home and "a reference point for other discussions with congressional staff," Burke said.

The AAFP played a direct role in shaping the provisions of the bill, consulting frequently with staff members from both Durbin's and Burr's offices on elements to include in the legislation. Burke said the soon-to-be released legislation is "close to an ideal bill," but is limited in scope because it only applies to Medicaid and SCHIP recipients.

"The best thing would be a bill that makes the medical home permanent throughout Medicaid and Medicare," said Burke.

Durbin's and Burr's legislation is based, to a large extent, on North Carolina's Medicaid management program, which is known as Community Care of North Carolina, or CCNC. The North Carolina program comprises a group of physician-led networks that rely on the patient-centered medical home and other mechanisms to save costs and improve health care quality. Durbin's and Burr's legislation is an attempt to bring the success of the CCNC to other states.

Allen Dobson, M.D., the former assistant secretary of the North Carolina Department of Health and Human Services, outlined some of the provisions of the CCNC during a Sept. 13 congressional briefing in Washington sponsored by Durbin's and Burr's offices. Dobson told attendees that the CCNC program focuses on quality, utilization, cost-effectiveness and the management of care.

The CCNC originated in the late 1990s as a primary care-based case-management program that linked Medicaid recipients to primary care physicians. However, that program proved ineffective in improving quality and controlling costs. Officials then expanded the initial concept, creating collaborative networks that are linked throughout the state. Since its inception, the CCNC has expanded to encompass 15 networks, 3,500 primary care physicians and 1,000 medical homes. It has, in the process, saved millions in Medicaid costs.

According to Dobson, the program spent $8.1 million between July 2002 and July 2003, but it saved more than $60 million compared with what would have been spent without the CCNC. In addition, between July 2003 and July 2004, the CCNC spent $10.2 million but saved $124 million, said Dobson, citing figures from an analysis conducted by Mercer Human Resource Consulting Group. Cost analysis figures for 2004-05 and 2005-06 are embargoed until next month, but they will show similar cost savings, said Dobson, who currently is president and CEO of Cabarrus Family Medicine in Concord, N.C.

At the same time, the program has dramatically reduced emergency room visits and now operates at a 4 percent annual growth rate. During the past year, the legislature has mandated that the state's entire SCHIP population and all of the aged, blind and disabled patients covered by its Medicaid program be added to the CCNC.

Dobson stressed that the CCNC is physician-led, which is perhaps the single most important factor in making the program work. "We have to engage the doctors, or we will not control health care costs," he said.

The CCNC, he pointed out, "empowers primary care physicians to really improve the care of our Medicaid recipients."

Dobson is convinced that "key attributes" of the CCNC can be replicated in other states, and he added that the program relies on the public sector to drive private partnerships.